What is depression?
Clinical depression is a mood disorder characterized primarily by sadness or loss of pleasure or interest in most things. It appears to have a strong biological and genetic basis. An estimated 15 million Americans have suffered at least one major depressive episode. Depression occurs twice as often in women as in men. Despite tremendous advances in treatment, many people needlessly suffer silently and never seek help.
There are two types of depression, episodic and chronic. Episodic depression, called major depression, is diagnosed after depressive symptoms are present consistently for at least two weeks. If symptoms of mania also occur, the condition is called bipolar disorder, also known as manic-depressive disorder. There are two other subtypes of major depression. Postpartum depression occurs in women after childbirth. Symptoms typically appear within four weeks of childbirth; however many specialists believe they can occur anytime within the first year. Seasonal affective disorder, or SAD, is diagnosed when symptoms appear during fall and winter when sunlight is reduced. People feel better with the onset of spring.
Chronic depression, or dysthymic disorder, is diagnosed when depressed mood has been present most days for at least two years. Symptoms are less severe, but because they are so persistent and chronic, this disorder can be quite disabling.
What are the symptoms?
Symptoms most commonly associated with depression are:
- Sadness or loss of interest or pleasure in nearly all activities for a period of at least two weeks
- Increase or decrease in appetite
- Weight gain or weight loss
- Increase or decrease in sleep
- Decrease in sex drive
- Restlessness or agitation, or else feeling slowed down
- Loss of energy
- Feelings of worthlessness or guilt
- Diminished ability to think or concentrate
- Recurrent thoughts of death
- Some depressed people feel sad, some feel “blah,” and some report they have no feelings at all. Some feel anxious and irritable. Some depressed people report bodily aches and pains more than sadness.
Sometimes physicians and psychotherapists will work together to review all of your symptoms and determine whether they are part of major depression, another medical condition, another psychological disorder, or some other problem.
Do I need psychotherapy?
Some people who feel depressed will feel better simply through talking with friends or family, changing priorities, increasing exercise, reducing stress, and making changes in their relationships. When these efforts do not help sufficiently, psychotherapy is a place to seek help, and to improve quality of life in a deeper and more lasting way.
Individual and group therapy for depression can have unexpected outcomes. Although you are coming to therapy to find out how to relieve depressive symptoms, you may instead learn to identify and express feelings more effectively, negotiate for yourself in relationships, and become your own best expert in identifying triggers for depression and why they exist. You may come to appreciate your tendency toward self-blame. You may learn to take control of situations previously thought to be impossible to influence, and to comfort yourself when you are upset.
Group therapy is now a common form of treatment for people who suffer from depression. Because it is affordable to most people even without insurance, they can stay with a group long enough to achieve more lasting benefits. Many people find that when they talk about depression in a group, they feel less alone, more understood, and more accepted.
Should I take medication?
Most research indicates that a combination of psychotherapy and medication works most effectively for clinical depression. Over the past decade, enormous progress has been made in the development of safer, more effective antidepressants that have fewer and more tolerable side effects. In addition, there are new classes of antidepressants that work biochemically in different ways, so your physician has more kinds of medications with which to work.
The decision to take medication is dependent on many factors that should be discussed with your therapist and with your physician. Such factors include the severity of your symptoms, the degree to which depression impairs functioning, your past history of depression, your experience with antidepressants, your general medical history, other medications you are taking, and potential risks and side effects. The more severe your symptoms, the more likely you are to benefit from medication. For milder forms of depression, psychotherapy alone is often sufficient.
Image courtesy of Master isolated images at FreeDigitalPhotos.net